IT Band Syndrome Diagnosis and Treatment

[Cody Draper]

I have decided to consolidate (taken from the Fastrunning blog) some common running injuries to the discussion board.  So here we are at Volume 1 - ITBS (Iliotibital Band Sydrome)
I am no expert on this topic and I am certainly not a doctor.  I DO have symptoms of this injury so I will be happy to relate what I have learned.
DIAGNOSIS

    * Excessive friction between your Iliotibial Band and your knee (or hip) bone.
    * This causes a sharp pain at either the side of your knee or the side of your hip.
    * Usually caused by increasing your running or biking too fast and/or with bad form.
    * But is also associated with weight-lifting (standing squats), court sports (raquetball, tennis, handball, etc) and even pregnancy.
    * Most commonly occurs in one or both knees (see diagram at left), but can also appear at the hip joint. This is not uncommon at pregnancy, where the tendons loosen a bit and the weight distribution shifts.  I’ve never heard of any hip-specific exercises or stretches, but think the general ones should help at the hip as well. (http://www.itbs.info/html/what_is_itbs.html)

CAUSES
   (http://www.itbs.info/html/causes.html)
   1. Leg length differences
   2. Road camber - running on a slope for a long time
   3. Foot structure
   4. Excessive shoe breakdown - particularly it the outside of the heel
   5. Training intensity errors - increasing mileage or intensity too fast
   6. Muscle imbalances - particularly quads versus hamstrings
   7. Run/gait style factors - e.g. bow-leggedness, knock knees, etc.

Treatments
   (http://www.itbs.info/html/treatments.html)
   1. STOP RUNNING to prevent further inflammation, don't just ease off
   2. RICE (Rest, Ice, Compression, Elevation). Ice
   3. Anti-inflammatory drugs
   4. Stretch ITB at least twice a day, 30-60 seconds each side, using at least 2 different stretches.
   5. Self-massage of area, across the thighs and calves

Fellow Bloggers have given me the following tips:
-Ice
-Stretch
-Ice baths
-Elliptical
-Massage hamstrings and buttocks
Scott Browning shared these thoughts (http://cody.fastrunningblog.com/blog--My-leg-was-really-sore-all-day-yesterd/11-01-2007.html) with me and I think he is on the right track:
"IT band pain usually is caused by tightness in the glutes and Tensor Fascia Latae. Google stretches for TFL, piriformis, and glutes. Deep tissue massage throughout your pelvis and especially the glues should make a difference. As far as ice, freeze a small dixie cup and do an ice massage across the IT band insertion. Ice massage should last about 7 minutes or until the area numbs, any longer and you risk frost bite. If you have access to a foam roller you can roll out the IT band and the glutes. Good luck, and I hope you are healthy soon. By the way, does it hurt walking down the stairs. IT band pain is usually worse with the knee at 45 degree during the stance phase of running gait. Going down stairs will often replicate the pain."

I am not sure if I am willing to take a whole chunk of time off to let my own injury heal, but after reading that website, I am wondering if my 5 miles a day is making it worse.  Here is another article that gives an exercise to strengthen the IT band http://www.sportsinjurybulletin.com/archive/0168-knee-injuries.htm

I would be interested in more ideas and tips to help.

[Adam R Wende]

I have to say you have hit all the best advice I could give. I also have to add that I dealt with this on and off all four years in college. The good news is I've had no major symptoms with ITBS in last 7yrs. I've had some other secondary complaints but not the same deal. The two main things that helped me were regular stretching and icing. 

[adam]

A good stretch for that is the basic pre-game stretch you learned as a kid; cross your legs and try to touch your toes.

Another thing on the ice treatment. 7 minutes would not risk frostbite on the leg. I can't remember exactly what time is standard for leg vs arm vs foot vs hand (each is a bit different, changes btw ATC's and PT's, but most are 12-18 minutes) and more than 7 minutes isn't going to hurt it much outside of some short-term numbness and redness. A few of the cases of frostbite that I've heard of from cryotherapy have come from people who've put their foot in a bucket of ice overnight (which is way too excessive) and some have expierenced short-term numbness of the nerves on the back, leg, or arm after extended periods of icing (still much longer than 20 minutes). In any case the highest risk would most likely occur on the toes and fingers where the blood supply is minimal, not on the leg (where there is ample blood supply). Besides, after about 10 minutes with a dixie cup ice ball, its close to melted anyways.

[Josse]

I have found a wonderful tool used for scraping or Gua Sha as the chinese call it, physical therapist call it Aystem.  But I love it.  I have done massage for over 10 years and know many differant techniques and use them all.  But for breaking up all that crunchy stuff we accumulate in our muscles (that is usually the culpret of all those injuries and imbalances) from all the miles we put in this tool works better than anything I have ever tryed.  I use it on myself weekly.  You can find it as www.guashaorthopedic.com.  It come with a booklet with info, but the tool is pretty easy to use.  You just hold it at a 45 degree angle and scrap it (with a thick cream) across the area.  Areas that need it turn red really fast,  and bruising of various shades of beautiful reds and browns are common, this is stagnet blood that is coming to the surface.   These areas need alot of attention and should be dune every couple of days until you don't get that redish brown bruising any more and then just do maintence on that area.  Any who the Chinese have been using this method for thousands of years. 
Oh yes and we all need to work on our streaching!  This help tremdously in imbalances as well you just have to do it.  If anyone has questions about Scrapping I am willing to share what I know.

[Paul Petersen]

Is this scraping thing the same as Graston?

[Josse]

Yes but with Graston I think they use metal tools, Gua sha uses jade, bone, or plastic tools.  In fact the same guy came up with both the graston and aystem tecniques.  Same idea just alittle bit differant tools, but they all came from gua sha.

[Dallen]

I am a doctor, but my injury knowlege is firsthand. They don't teach much about overuse running injuries in med school.

I had ITBS and tried everything I could find to get rid of it. Nothing worked. I just dealt with it for over a year. I have run through every other injury that I have had, but I think this is one that really does require rest. I think six weeks off is better than a year of bad training, especially since it is the "offseason".

[Ruth Hilton]

If anyone has questions about Scrapping I am willing to share what I know.

So, do you 'scrape' yourself or do you have somebody else do it to you?

I had ITB tendinitis a couple of years ago. I had quite a bit of physical therapy with it and ended up taking off 2 months for it to heal so I could run again. One thing at PT they did that I think helped a lot was stretch out my ITB. Not just by stretching myself, but (as weird as it sounds) they took a plunger to it. They just used a LOT of lotion so it would slide on my skin while being suctioned onto my leg and slid it up and down the ITB. I was pretty doubtful when they first did it - there was the HUGEST bruise there for a while, but it really loosened up the ITB well. 

[Cody Draper]

One thing at PT they did that I think helped a lot was stretch out my ITB. Not just by stretching myself, but (as weird as it sounds) they took a plunger to it. They just used a LOT of lotion so it would slide on my skin while being suctioned onto my leg and slid it up and down the ITB. I was pretty doubtful when they first did it - there was the HUGEST bruise there for a while, but it really loosened up the ITB well. 

Weird!

So based on what people are saying this is a scary injury and it would be better to take time off than to risk having it A. Either get worse or B. Become chronic and rear its ugly head forever.
That leaves me in a pickle.  How do I satisify my crazy insatiable desire to run when I can't run?  Will it be worth it?  I keep telling myself that I can just take it easy for another week and it will magically go away (with doing everything I can other than taking time off). 

[Josse]

I do scrape myself.  I think we need to do self care to stay healthy and I can put myself in pain.  The pluger thing is like cupping, which is another chinese method (the chinese are brilliant).  This also get that stagnet bloode to the surface and allows fresh, healing bloode to do its healing.  Much like the scrapping does, but the scrapping works alot more stuff out. 
Cody- I think we have to judge ourselves if we can run through an injury.  Sometimes I can and sometimes I can't.  You just have to be carefull, maybe back off for a while, try some crosstraining and give your body a break from the intense running.  But just taking time off will not get rid of an injury.  You have to do something to get rid of it.  Do you stretch?  This is very important and is why most of us create imbalances in our bodies which lead to injury.
I have found that the "weirdest" thing I have tryed are the most effective.

[Ruth Hilton]

Also, try massage - the deep tissue kind by a really good therapist does wonders - sometimes your issues can be caused by odd tightnesses in your muscles and from them being slightly out of place from hard workouts and such - a good therapist can work them out really well and keep chronic-type injuries away better.

[Josse]

 I don't know why I didn't think of this before but I have worked on many IT band cases and for years this was one of my most difficult things to figure out until I got a touch of it myself.  Only about 98% of IT promblems aren't actually true IT band syndrome (my experience any way and I have seen alot).  I figured out that is caused by tight deep hip flexors mainly the Periformis muscle and the Vastis Lateralis (outside quad muscle).  I found by working the vastis lateralis and showed the person some good stretchs to open up the hips the problem got better way faster than if I just worked on the IT band.  Every person is a little bit differant but this has been true to most of my clients with IT.  What I would do is start doing some good hip stretchs and get a rolling pin and start rolling out that quad, focus on the outside, a couple time a day.   You can also get a hard ball and put it right in the middle of your buttock and lay on it, move it around untill you find a spot that really hurt and hang out there untill  the pain lessen then move it around untill you have worked out all those sore spots, repeat on the other side.  I would also work the other quad at least once a day.  Did you ever think running would be so much work

[Lulu]

What about ART (Active Release Technique)?

[Alexander]

I find that when I do more and adequate stretching before and after that helps reduce my IT problem. Use ice and ibuprofren too. I use a foam roller at times - its painful but helps. At work sometimes I roll a tennis ball around.
Ive bought a "aqua jogger" to use in swimming pool but havent had time to use it as an alternative

[Alexander]

Last reply was listed as Alexander - it should be Michael - my 10 year old does not have IT band problem. (we do our blogs at same time sometimes and forget to change name)